Ragazzo Filippo (Università degli Studi di Padova, Padova, Italia)
Ferrari Silvano (Università degli Studi di Padova, Padova, Italia)
Acute back pain is a common condition that constitutes a significant global public health issue. It has a high incidence among the population and impacts quality of life, work capacity, and socio-economic costs. Guidelines for the treatment of Acute Low Back Pain recommend the use of non-pharmacological treatments as the first-line approach, emphasizing the use of manual therapy, therapeutic exercise, patient education, and information as primary treatment modalities. However, these guidelines do not specify how early the treatment should commence. Individuals presenting at the Emergency Department (ED) for this type of back pain might help us understand whether early physiotherapy could be beneficial in reducing pain and disability.
From this framework, the authors have decided to develop a protocol for a Randomized Controlled Trial of superiority with two parallel groups with the aim of verifying the effectiveness of an early physiotherapy intervention in patients with Acute Nonspecific Low Back Pain in the Emergency Department.
Participants with acute back pain presenting at the ED will be consecutively recruited and assigned to two intervention arms via simple randomization, based on inclusion and exclusion criteria. The experimental group will meet with a physiotherapist within 4 days of ED admission to receive information about their condition, education on biopsychosocial factors, and a simple spinal muscle activation exercise, supported by a video for home practice. A follow-up phone call will occur one week later. The control group will receive standard ED physician recommendations and an initial physiotherapist assessment. The primary outcome is pain measured by the NPRS scale. Secondary outcomes include disability (Roland-Morris Disability Questionnaire), general health (EuroQuol 5D-5L questionnaire), Global Perceived Effect, and return-to-work date. Both groups will be assessed at 1, 3, and 6 months from the initial visit.
Currently, 30 participants have been recruited, 23 of whom have completed the first scheduled follow-up, and 9 have finished the entire study. Participant recruitment is expected to be completed by the end of June 2024, and the study, including data analysis, is anticipated to be completed by the end of this year
We need to wait until the end of the study to conduct a thorough analysis of the obtained data. However, some significant elements can already be observed: participants have shown engagement and felt reassured by the prospect of being followed up by the physiotherapist. The experimental group appreciated the supportive phone call one week after the first appointment, as it provided further clarification and strategies to manage their pain in the initial period. This confirms the importance of offering explanations and practical solutions for carrying out daily activities, as emphasized in all current guidelines.
The main limitations of this study are:
-the heterogeneity of the sample characteristics does not allow for a detailed evaluation of subgroups of patients with back pain who might benefit more or less from this type of intervention;
-intervention and assessments are conducted by a single physiotherapist, who is also responsible for data collection during the follow-ups.
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